NBHSW – Peer Review Summary Document
Introduction
Peer reviews have taken place for all assessments completed following referral from
Newborn Hearing Screening Wales since March 2007. An inter-divisional, All Wales,
rotational allocation of peer reviewers has been running since June 2009.
All individuals undertaking NBHSW assessments are expected to take part in peer
reviewing.
This document outlines the roles of both the tester (in preparing and sending documents
for review) and the reviewer (in terms of completing the peer review and associated
paperwork).
The flow chart (Appendix A) summarises the process.
Tester
Testing should be performed as per current NBHSW/NHSP Assessment Guidelines.
The following documents should be sent, electronically for peer review within 14 days,
or less, of final assessment date (see ‘Process and requirements for the electronic
storage and transfer of NBHSW traces for the purpose of Peer Review – v1.2’ for further
information):
Completed Results Record Sheet
 Demographics: Initials, date of birth and NHS number as
only patient identifiable data.
 Other Information: Must include gestational age of baby, risk
factors where known and referral reason eg. Bilateral no
clear AOAE.
ABR Printouts
 Demographics: initials, date of birth and NHS number as
only patient identifiable data. Date of test should be present.
 Test Parameters:
collection and stimulus parameters,
including amplifier gain/sensitivity and filter settings,
transducer, stimulus rate, type and intensity
 Display: - any waveform markers to be removed
- appropriate latency/amplitude ratio and with
traces optimally superimposed
NBHSW Peer Review Summary v1.0 – November 2013
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-
-
presentation of traces should be a maximum of 8
pairs (including averaged waveforms) per window,
and only one frequency and stimulus type per
window
tone pips and CMs should not be displayed
together
use of ‘show flat line’ as appropriate (see ABR
guidance document)
Additional Tests
 Tympanometry/OAE and any other tests performed should
contain minimal patient identifiable data (as above)
Timescale
 It is advised that testers keep a record of the dates that
assessments were sent for peer review and log their return
to ensure timely turnaround, so that results can be chased if
necessary.
Peer Reviewer
Timescale
 Peer review should be completed and returned within 28
days, or less, of last planned assessment date
 It is advised that the peer reviewer record date of receipt of
assessment and date of return
Practicalities of Peer Reviewing
 Traces should be reviewed without having seen tester’s
interpretation, therefore, waveforms should be analysed
before referring to Results Record Sheet
Waveform Analysis: The following points should be checked
- Test parameters as per current recommendations
- Sweep number as per protocol
- Use CR, RA and Inc guidelines in assessment
protocol to inform waveform interpretation
- Use masking noise calculator to check if masking
needed or not (where necessary)
- Decide on threshold per stimuli/transducer
(including relevant correction factors)
- Check that ‘gold standard’ has been met for at least
one frequency and for each transducer in each ear
NBHSW Peer Review Summary v1.0 – November 2013
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Other Traces:
information
Check correct test settings used and analyse
Results Record Sheet:
- check all information required is present
- check minimal patient identifiers (see Tester role)
- check threshold analysis of tester against your
levels, including use of correction factors
- look at notes on test for explanation of tests not
performed etc.
- look at summary and conclusions drawn and check
that they agree with tester’s interpretation
- check that you agree with interpretation, summary
and conclusions
Peer Review Audit Form (see Appendix B)
Complete each of the drop-down boxes in the form and then
consider whether the statement ‘Suitable management plan in
place based on an appropriate assessment of hearing status’ is
agreed with for the assessment under review




If all is fine, complete form and return, electronically, to tester
within 28 days, or less, of final planned assessment date
If any of 1-7, and/or overall statement is recorded as ‘no’, or
if further information is needed in order to fully consider the
case, then contact should be made with the tester as soon
as possible
Once exchange between peer reviewer and tester is
concluded, the peer review audit form should be completed
(with details of the discussion/’no’) and returned,
electronically, to the tester within 28 days, or less, of final
planned assessment date
If agreement cannot be reached between peer reviewer and
tester, this should be notified to the Tester’s Divisional Coordinator (DC) who will seek further independent review of
the case.
Confirmed Discrepancies
If, on completion of the peer review, there is an agreed
discrepancy, the Peer Reviewer will return the completed Peer
Review Audit Form electronically to the Tester and copy it to the
Tester’s DC.
NBHSW Peer Review Summary v1.0 – November 2013
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In addition, the peer reviewer should send copies of the Peer
Review Audit Form, Results Record Sheet (and where
appropriate, waveforms) to the Tester’s Divisional Audit
Facilitator (DAF), ensuring that any documentation is
anonymised.
Where the discrepancy is due to the Peer Reviewer exceeding
the 28 day turnaround time, the discrepancy should be reported
to the Peer Reviewer’s DC and DAF, and also to the Tester’s
DC.
The peer reviewer should keep either paper or electronic copies of the traces, Results
Record Sheet and completed Peer Review form.
Please note that the Peer Reviewer role is for Quality Assurance of the assessment,
against nationally agreed protocols, and is not a mechanism for ‘coaching’ or providing
advice/personal opinion on testing.
Divisional Audit Facilitator
The role of the DAF in peer review is simply to hold an anonymised record, per Division,
of reported discrepancies, and to ensure that the relevant DC is aware of these
discrepancies. The DAF is also expected to feed back discrepancies at Divisional/All
Wales meetings.
The DAF may be contacted with regards to procedural queries, but should not be used
for second opinion of traces.
Divisional Co-Ordinator
The role of the DC in peer review is to be aware of discrepancies within the Division and
to take action should completed peer review indicate that further investigation/change to
management plan is needed.
In the case of serious errors, the DC will notify the Programme Lead and the Director of
Screening.
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PROCESS FOR PEER REVIEW




Assessment completed by Audiologist who then sends for peer
review:
copy of all relevant anonymised traces with wave and patient
identifiers removed. NHS number must be provided.
trace summary sheet (if not automatically printed from equipment)
Results Record Sheet to include date sent for peer review
tympanometry print out/results of any other additional tests performed
within 14 days, at latest, of last planned assessment date



Peer Reviewer:
Notes date received for peer review on Results Record Sheet
Completes peer review audit form
Provides reason on peer review form if not completed and returned
within 28 days, at latest, of last planned assessment
within 28 days, at latest, of last planned assessment date
Peer Reviewer:
 Returns completed
audit form to
Audiologist who
records peer review
undertaken
 File peer review audit
form, traces and any email correspondence
No Queries
Query Raised
(i.e. any answer on Peer Review Audit Form
checklist = no)
Peer Reviewer then:
1. Has discussion with Audiologist**
2. E-mails a summary to Audiologist copy to
reviewee’s Divisional Co-ordinator in the
first instance
Audiologist:
 Files completed peer
review
 Where no reply received
within 28 days of last
planned assessment, to
chase reviewer, and if
necessary contact
reviewer’s DC
 Where reply received
outside of 28 days report
this to reviewer’s DC and
DAF and to own DC for
recording as discrepancy
Feedback where
appropriate
Peer Reviewer:
sends copy of all paperwork to reviewee’s
Divisional Audit Facilitator (anonymised tester ID removed)
Divisional Audit Facilitator:
 File Paperwork
 Add discrepancy details to Divisional spreadsheet
and send to DC
 Summarise queries at All-Wales Audit Meeting
Divisional Co-ordinator:
 Immediately notify Director of serious errors
 Summarise queries for All Wales Management
** where agreement cannot be reached between Tester and Reviewer, the Reviewer is responsible for sending the assessment to
NBHSW
PeerDC
Review
Summary
– November
2013
(Jackie
SEW) of result of independent review, the
5 Harding,
the Tester’s
who will
send on v1.0
for further
independent
review
within
Wales.DAF
On receipt
processes of the peer review should be completed.
APPENDIX B
NBHSW DIAGNOSTIC ASSESSMENT PEER REVIEW AUDIT FORM
Number of Review (Allocated by Reviewer) ………………………….
NHS Number …………………………
Initials ..…………
Date of Birth ...……………..
Reviewer must make decision on threshold before looking at trace summary sheet
Suitable management plan in place based on appropriate assessment of hearing
status
Yes/No
1
2
Yes/ No
Yes/No
3
4
5
6
7
8
9
Correct test parameter used
Frequency-specific air and bone conduction thresholds established as per
protocol
Agreement between reviewer/audiologist analysis of traces? (significant
discrepancy is ≥10 dB difference in threshold)
All traces and parameter summary provided. NHS number, DoB and initial
only as identifiers. Waveform markers removed
Result record sheet correctly completed, including appropriate correction factor
application
Traces sent for review ≤14 days of last planned assessment date*
Peer review completed and result returned ≤28 days after last planned
assessment date*
Discussion required
Discussion resulting in change to plan
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
*where date not provided on results record sheet, sent date will be considered to be the date received by peer reviewer
If any of 1-7 are answered ‘no’, or there are any comments regarding discussion/management plan – give
details below
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………
Actions
Feedback to Audiologist (all assessments)
Feedback to Audiologist and Divisional Co-ordinator if any discrepancy
For discrepancies, copy of traces and review to Divisional Audit Facilitator (Audiologist’s
name to be removed)
Name of Reviewer: ………………………………………………………………..
Date Review Completed and Sent Back: …………………………………………………………..
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Yes/No
Yes/No/NA
Yes/No/NA
NBHSW Peer Review Summary v1.0 – November 2013
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